Disc Degeneration:
Chronic back pain is a significant health problem associated with degeneration of the intervertebral discs. Traditionally, treatment is varied and focused on the symptoms instead of at the root of discogenic back pain, the disc itself. The more conservative approaches include general exercise, specific conditioning of back and abdominal muscles to help stabilize hyper-mobile regions, spinal manipulation to increase the range of motion for hypo-mobile regions, massage therapy, and transcutaneous electrical nerve stimulation. The more invasive treatments involve the use of medications such as analgesics, opiates, anticonvulsant agents, or antidepressants; minimally invasive treatments such as acupuncture, epidural, and facet joint corticosteriod injections, and spinal nerve blocking techniques. The most invasive treatments involve surgical intervention, ranging from microdiscectomy and spinal fusion to laminectomy.
Despite the multitude of treatments and clinical studies, discogenic back pain still remains one of the most elusive ailments of our time and lacks standardized guidelines for treatment that uniformly achieve acceptable results. In fact, within the framework of evidence-based medicine, the best treatment for discogenic back pain remains cognitive intervention combined with physical exercises specific for stabilizing the spine.
The mechanical properties of the intervertebral discs play an important role in their functionality. Disc degeneration is often characterized by reduced disc height and increased stiffness, leading to bulging or herniation which can create pressure on the radiating nerves and spinal cord. The dominant treatment at present is spinal fusion, wherein two or more adjacent vertebral bodies are physically locked together using bone graft or instrumentation. While this procedure often successfully eliminates stenosis and restores disc height, thus reducing nerve pressure, degeneration of adjacent motion segments is a common long-term complication through negative changes in joint dynamics.
Mean Axis of Rotation:
Patients with neck pain typically do not exhibit obvious abnormalities in plain neck radiographs. Noting the lack of effectiveness of neck range of motion investigations, investigators began exploring the notion of the quality of motion of the cervical vertebrae, they reasoned that while range of motion may be normal, abnormalities of the cervical spine might be revealed by abnormal motion patterns within individual joints. When a cervical vertebra moves from full flexion to full extension, its path appears to lie along an arc whose center lies somewhere below the moving vertebra, this center is called the mean axes of rotation [MAR] or Instantaneous Axis of Rotation [IAR] and its location can be determined using geometry. van Mameren et al. (1992) showed that in contrast to cervical range of motion, a given MAR can be reliably calculated within a small margin of technical error (11).
Abnormal Mean Axes of Rotation:
Abnormal MARs were investigated by Amevo et al. (1992), who studied 109 patients with post-traumatic neck pain (13). The MAR locations were subsequently compared with previously determined normative data. It emerged that 72 percent of the patients with neck pain exhibited at least one abnormally located cervical MAR. The relationship between axis location and pain was highly significant statistically [P<0.001]. However, there was no evident relationship between the segmental level of an abnormally located MAR and the segment found to be symptomatic on the basis of provocation discography or cervical zygapophysial joint blocks.
Gene Expression in the Nucleus Pulposus:
The intervertebral discs (IVDs) provide mobility and a degree of shock absorbance to the spinal column. They also transmit forces between the adjacent vertebrae and prevent direct contact between the bones. It has been shown that the mechanical properties of the intervertebral discs play an important role in their functionality. Disc degeneration is often characterized by reduced disc height and stiffness, resulting in pressure on the radiating nerves. The dominant surgical treatment at present is spinal fusion, wherein two or more adjacent vertebral bodies are physically locked together using bone graft or instrumentation. While this procedure often successfully restores disc height and allows for the return of a pain-free lifestyle, degeneration of adjacent motion segments (adjacent segment disease) is a common long-term complication. While initially thought to be a rare event, adjacent segment disease is becoming more of a concern. One current theory states that by fusing dynamics of the joint, they are altered in a way that affects the healthy discs next to the fused segment, likely by altering loading and kinematics on these adjacent discs.
Vibration Treatment:
Vibration treatment has been used for centuries for the treatment of various ailments. Initially, treatment was provided with bare hands. As it became evident that a more controlled method of treatment was needed, devices and protocols were developed to provide a controlled vibration. As a result, we now have methods for increasing bone density, for reducing pain associated with osteoarthritis and soft tissue injury and for reducing lower back pain, to name a few. For example, McLeod (5376065) disclosed that sinusoidal waves having a frequency of 10-110 Hz with an amplitude of 0.01-2 mm and an acceleration of 0.05-0.5 g can improve bone density in patients. Mathes (US Publication No. 20100121131) disclosed that any waveform ranging in frequency from 1-146 Hz with an acceleration of 0.05-0.5 g can reduce pain associated with osteoarthritis and soft tissue injury. Desmoulin et al. (Journal of Musculoskeletal Pain, Vol 15, 3 pp 91-105) and Desmoulin et al. (Clinical Journal of Pain, Vol 23, 7, 576-585) disclosed the use of the Khan Kinetic Treatment (KKT) for reducing lower back pain. The treatment involved vibration at 80-120 Hz with a maximum displacement of 5 mm, however, it was suggested that the frequency could range from 20-300 Hz. The treatment device used is disclosed in Khan et al. (US Publication No. 20080312724), which is incorporated herein in its entirety by reference. The device delivers multiple impulses of variable frequency and variable force in a linear direction, as well as rotational forces, for patient treatment. The apparatus produces smooth sinusoidal waveforms ranging from 50 to 110 Hz for treatment of spinal and upper cervical vertebrae.